Use of Tragus Cartilage for Grafting

Abstract

Sir: We read Singh and Bartlett’s article in Plastic and Reconstructive Surgery1 with great interest and think it is very remarkable to remember, as the authors did, all the applications of ear cartilage for facial reconstruction. We would like to add a small contribution describing a possible source of cartilage that is not normally considered. Removal of tragus cartilage does not have any functional or aesthetic effects; the cartilage itself can be easily used for composite or simple cartilage grafting. We have used it many times both for columella reconstruction (as a composite graft) and in secondary cleft lip operations (as a simple graft) to rebuild the Cupid’s bow. Careful examination of tragus cartilage and comparison with the Cupid’s bow reveals how similar they are in size and shape (Fig. 1). We normally draw the tragal cartilage passing through a retrotragal incision to avoid scarring and remove the cartilage only. The perichondrium is left intact to preserve the consistency of the tragus. The excised cartilage is then positioned at the Cupid’s bow level after a suitable subcutaneous space is prepared by means of a small incision in the lip mucosa (Fig. 2). The aesthetic effect is truly remarkable. The only possible problem is a difference in cartilage consistency. However, if the cartilage is inserted sufficiently deeply in the lip, only a slight thickening will be felt on palpation. This does not alter in any way the sensitivity or natural effect of the result obtained.Fig. 1: . Cleft lip revision in a 36-year-old woman. Marking denotes the tragus of the cartilage that will be placed on the lip.Fig. 2: . Intraoperative view of the graft ready to be inserted at the level of the Cupid’s bow.Fabio M. Abenavoli, M.D. Andrea Servili, M.D. Roberto Corelli, M.D. Chirurgia Plastica ed Estetica San Pietro Hospital, Fatebenefratelli Rome, Italy